The national System-wide Paediatric Observations Tracking (SPOT) programme recently developed a Paediatric Early Warning System (PEWS) to standardise the identification and management of deteriorating children across healthcare contexts in England.1 One component of this is the PEWScore, calculated based on age-normative vital sign thresholds. This was developed following review of existing scoring systems, and refined following testing in 15 UK sites.2

In this retrospective electronic health record study in our tertiary children’s hospital, we evaluated the performance of the SPOT PEWScore in recognising inpatient adverse events (AEs), defined by the need for an emergency ‘#2222’ call, or unplanned intensive care unit (ICU) admission. AE data were matched to the most recent recorded observation data. SPOT PEWScores were calculated retrospectively and compared with the Bedside PEWS score (BPEWScore), currently used in our hospital based on previous validation work.3 4 The two scores differ on age boundaries, vital sign thresholds and the incorporation of breathing support data. …